100例门诊中重度老年癌痛患者使用3种阿片类药物疗效回顾性分析

目的回顾性分析100例门诊中重度老年癌痛患者3种阿片类药物疗效及不良反应情况。方法选择100例中重度老年癌痛患者(≥60岁),规范单一使用硫酸吗啡控释片、盐酸羟考酮控释片及芬太尼透皮贴剂3种阿片类药物,利用简明疼痛调查量表(BPI)对患者治疗前、后镇痛效果及不良反应情况进行调查和分析。结果患者药物治疗后数字分级评估法(NRS)评分较治疗前低(P<0.05)。疼痛缓解总有效率为91.0%。药物的主要不良反应有便秘、恶心呕吐、排尿困难、嗜睡及瘙痒、精神症状等,年龄越大药物不良反应越明显。芬太尼贴剂组患者不良反应不如其他2组明显(P<0.05)。结论 3种阿片类药物对中重度老年癌痛患者均有效,药物选择要兼顾老年患者特点及药物特性,药物不良反应不可忽视,应采取综合措施防范。     

芬太尼透皮贴剂与口服控释吗啡治疗癌痛的自身对照研究

对35例需强阿片类药镇痛的晚期癌患者进行芬太尼贴剂的口服控释吗啡的自身对照治疗,以比较两药控制癌痛的疗效及安全性。结果发现,两药治疗癌痛的总体缓解率、副反应谱及发生率相近,但芬太尼贴剂控制癌痛的完全缓解率略高于口服控释吗啡（P＜0．05）,便秘的发生率略低（P＜0．05）。认为芬太尼透皮贴剂作为WHO第三阶梯镇痛药具有与口服吗啡相近的疗效和安全性,尤其适用于不能口服镇痛药的癌痛患者。     

缓控释强阿片类药物在老年癌痛患者中的应用分析

目的了解缓控释强阿片类药物在老年癌痛患者中的应用情况及用药趋势。方法对2008年1月至2010年12月在镇痛科就诊的776例年龄≥65岁的老年癌症患者使用缓控释强阿片类药物的情况进行统计和分析。结果缓控释强阿片类药物在老年癌痛患者的用量逐年增加,在硫酸吗啡缓释片、芬太尼透皮贴剂以及盐酸羟考酮控释片这三类缓控释强阿片类药物中,芬太尼透皮贴剂的用药频度位居第一,盐酸羟考酮控释片的用量增长迅速。结论本院老年癌症止痛治疗中用药是合理的。     

芬太尼透皮贴剂治疗晚期消化系统癌痛的临床观察

[目的]观察芬太尼透皮（商品名：多瑞吉）贴剂治疗晚期消化系统癌痛患者的镇痛效果及对生活质量的影响。[方法]选择中、重度癌痛患者28例使用芬太尼透皮贴剂，每张（贴）2．5mg（每小时释放芬太尼25mg）。72h更换1次，1周为1个疗程，评估记录治疗前后疼痛强度的变化、不良反应及生活质量的评分比较。[结果]全部病例均获得缓解。明显缓解和完全缓解者26例（92．9％），轻度缓解2例。不良反应有恶心，呕吐、头昏、嗜睡、便秘，但发生率较低。治疗后除生活自理能力外。其他5项主要指标均较治疗前明显改善（P〈0．05）。[结论]芬太尼透皮贴剂治疗晚期消化系统中、重度癌痛，镇痛效果可靠，安全，不良反应少，且使用方便，能明显改善患者生活质量。     

苏太尼透皮贴剂治疗癌痛的临床观察

芬太尼透皮贴剂(商品名多瑞吉，下称芬太尼贴剂)，是目前世界上唯一可以透皮吸收的强效镇痛药物。通过特殊给药装置系统一透皮治疗系统，将压缩在药物存储器中的芬太尼按照稳定的速度，通过控释膜输送到皮下再进入血液循环，进而发挥疗效。2001年以来，我院对40例中重度癌痛患者使用芬太尼贴剂，取得了满意的效果。     

芬太尼透皮贴剂联合吗啡皮下注射在晚期肝癌介入术后疼痛护理中的应用

目的分析芬太尼透皮贴剂联合吗啡皮下注射在晚期肝癌介入术后疼痛护理的应用效果。方法 2015年12月—2018年6月,于海军军医大学附属长海医院收治的晚期肝癌患者中选取86例,所有患者均行介入术治疗,将患者随机分为两组,各43例。对照组患者在术后疼痛护理中单独应用吗啡皮下注射,观察组患者则在术后疼痛护理中采用芬太尼透皮贴剂联合吗啡皮下注射,比较两组患者术后镇痛情况与药物副作用发生情况。结果与对照组比较,观察组患者治疗后2 h、治疗后12 h、治疗后24 h的NRS评分更低,组间差异有统计学意义(P0.05)。结论芬太尼透皮贴剂联合吗啡皮下注射在晚期肝癌介入术后疼痛护理的应用效果显著,值得推广。     

芬太尼透皮贴剂联合华蟾素治疗肝癌疼痛46例

为观察芬太尼透皮贴剂联合华蟾素对肝癌疼痛患者的镇痛效果,我院对46例肝癌癌痛者进行了观察,现报告如下.     

美施康定治疗中重度癌性疼痛25例临床观察

2001年9月～2002年10月，我院采用美施康定(硫酸吗啡控释片)治疗中重度癌性疼痛患者25例，效果满意．现报告如下。     

硫酸吗啡控释片治疗癌痛46例分析

2002年元月～2003年12月，我们以硫酸吗啡控释片治疗中、晚期癌痛患者46例，效果满意。现报告如下。     

以奥施康定为初始滴定治疗中、重度癌痛的疗效

目的观察以奥施康定为初始滴定治疗中、重度癌痛的临床疗效。方法有明确组织学诊断的晚期癌症患者,可准确评估疼痛强度,且数字评分量表(NRS)>4分,PS>2分,年龄≥18岁,既往未使用过奥施康定、盐酸吗啡片的患者随机分为治疗组和对照组,每组35例;治疗组:盐酸羟考酮缓释片(奥施康定)10 mg,q12 h口服,应用氨酚羟考酮(泰勒宁)1²片,长期备用医嘱,口服处理爆发痛。对照组:应用盐酸吗啡片10 mg,q4 h口服,盐酸吗啡片52片,长期备用医嘱,口服处理爆发痛。对照组:应用盐酸吗啡片10 mg,q4 h口服,盐酸吗啡片5¹0 mg,长期备用医嘱,口服处理爆发痛。两组均同时给予胃复安15 mg,2次/d.口服预防恶心、呕吐。芦荟胶囊2粒,1次/d,口服预防便秘。每天进行癌痛疗效评估,癌痛评价标准采用NRS评分法,记录盐酸羟考酮缓释片、泰勒宁及盐酸吗啡片用量。结果治疗组35例中,完全缓解(CR)11例,部分缓解(PR)16例,无效(NR)8例,总有效率77.14%;对照组35例中,CR 10例,PR 16例,NR 9例,总有效率74.28%;两组总有效率比较无显著性差异(P>0.05)。结论奥施康定与即释吗啡片均能有效缓解晚期癌症患者的疼痛,改善患者生活质量。以盐酸羟考酮缓释片为初始滴定与即释吗啡片相比,达到相同止痛效果的起效时间无差异,且奥施康定给药次数少,给药剂量小、不良反应较少、服用方便;24 h内对疼痛控制良好率奥施康定组明显优于即释吗啡片组,奥施康定组可以更迅速的缓解患者的疼痛;24 h内平均发生爆发痛的次数奥施康定组明显少于即释吗啡片组,且处理爆发痛后疼痛缓解时间上奥施康定组明显短于即释吗啡片组。     

Palliative Schmerztherapie, Cannabinoide

Cancer pain treatment should follow the recommendations of the World Health Organisation. Treatment should be with oral application, regular application times and following the analgesic step-ladder. Non-opioids such as dipyrone or non-steroids are used for slight to moderate pain, step-2 opioids such as tramadol or tilidine/naloxone for moderate pain and step-3 opioids such as morphine, oxycodone or hydromorphone for severe pain. Transdermal application of fentanyl or buprenorphine offer a non-invasive parenteral alternative for patients with stable pain syndromes.Cannabinoids such as tetrahydrocannabinol offer a valuable add-on option for cancer patients with refractory pain, spasticity, nausea or appetite loss.     

毫米波治疗晚期肺癌癌性疼痛的临床疗效

目的　观察毫米波治疗仪对晚期肺癌癌性疼痛的止痛疗效。方法　对 34例晚期肺癌合并肿瘤所致疼痛患者 ,其中轻度疼痛 2 2例 ,中度 11例 ,重度 1例。采用毫米波治疗仪治疗 (毫米波频率 36 GHz,波长 8.3mm) ,主辐射器照射主穴 ,副辐射器照射副穴 ,每次 30 min,每日 1～ 2次 ,每周 5日 ,一疗程 2 0次。结果　轻度患者止痛总有效率 (CR+PR+MR) 78.18% ,中度患者总有效率 72 .18% ,所有患者总有效率 70 .5 9%。治疗后疼痛打分下降 ,治疗时起效时间缩短 ,疼痛缓解时间延长 ,差别有极显著意义 (p<0 .0 1) ,未见明显不良反应。结论　毫米波治疗对轻、中度肺癌癌性疼痛有较好的治疗作用 ,值得进一步深入研究和推广     

Opioid use in osteoarthritis: From guidelines to clinical care

Three treatment guidelines for the treatment of knee and hip osteoarthritis (OA) which pick up the aspects of treatment supported by evidence have been published. Opioid drugs have an important role in symptomatic treatment. The guidelines, the effectiveness, and the safety of opioid analgesics in osteoarthritis, as well as its implications in clinical practice are reviewed. Tramadol is the opioid with the biggest evidence of effectiveness and safety, besides being the most used in clinical practice. Strong opioids (transdermic brupenorphine or fentanyl, oxycodone, and morphine) can be used in severe pain that does not respond to other treatments. Opioids can be used in patients that have moderate or severe pain or in those with inadequate response or intolerance to NSAID's. The opioids also have a sedative effect that facilitates sleep and can improve functional limitations and anxiety. The side effects are frequent; they usually appear at the beginning of treatment and are rarely severe, but frequently force to stop treatment.     

The use of rapid onset opioids for breakthrough cancer pain: the challenge of its dosing

Breakthrough cancer pain (BTcP) has been defined as a transitory increase in pain intensity on a baseline pain of moderate intensity in patients on analgesic treatment regularly administered. This review provides updated information about the use of opioids for the treatment of BTcP, with special emphasis on the use of new rapid onset opioids (ROOs). Due to its slow onset to effect oral opioids cannot be considered an efficacious treatment for BTcP. Parenteral opioids may provide rapid onset of analgesia, but not always available particularly at home. Different technologies have been developed to provide fast pain relief with potent opioid drugs such fentanyl, delivered by non-invasive routes. Transmucosal administration of lipophilic substances has gained a growing popularity in the last years, due to the rapid effect clinically observable 10-15 min after drug administration, obtainable in non-invasive forms. Fentanyl is a potent and strongly lipophilic drug, which matches the characteristics to favour the passage through the mucosa and then across the blood-brain barrier to provide fast analgesia. Transmucosal, buccal, sublingual, and intranasal fentanyl showed their efficacy in comparison with oral morphine or placebo and are available for clinical use in most countries. All the studies performed with ROOs have recommended that these drugs should be administered to opioid-tolerant patients receiving doses of oral morphine equivalents of at least 60 mg. The choice of the dose of ROO to be prescribed as needed remains controversial. The need of titrating opioid doses for BTcP has been commonly recommended in all the controlled studies, but has never been substantiated in appropriate studies.     

绵阳北川地区医生关于癌痛治疗的认知调查

目的了解绵阳北川地区医生关于癌痛治疗的认知情况,分析其中的错误观念及影响因素,进而探讨改进方案。方法选取北川羌族自治县人民医院和北川羌族自治县第三人民医院共50例医生进行问卷调查,包括内科、外科、中西结合科、针灸理疗科这些常见能收到姑息治疗的晚期肿瘤患者的科室。问卷内容除一般情况外,主要包括癌痛的基础知识、用药原则、影响吗啡临床应用的因素等。结果共发放问卷50份,回收有效问卷46份,有效回收率为92%。了解世卫组织推荐的《癌症三阶梯止痛指导原则》的医生仅有15.2%(7/46)。首选吗啡控释片治疗重度癌痛的医生仅有28.3%(13/46)。关于癌痛治疗基础知识的总体正确答题率仅为41.3%(190/460)。不同职称的医生间和是否接受过相关培训的医生间有关癌痛治疗基础知识的得分间差异均有统计学意义(P<0.05)。在医生认为的制约吗啡临床应用的消极因素中,影响程度很大的为“医疗卫生管理部门对吗啡的使用限制”,占65.2%(30/46),得分为3.5分;其次为“没有接受过镇痛治疗的专业培训”,占58.7%(27/46),得分为3.5分;“对药物成瘾性的顾虑”,占56.5%(26/46),得分为3.3分;“我国医疗卫生政策支持和宣传力度不够”,占54.4%(25/46),得分为3.4分。结论绵阳北川地区医生在癌痛治疗方面存在较严重的认知不足,非常需要开展相关专业培训和加强政策宣传来改善现状。     

Opioid treatment of painful chronic pancreatitis.

BACKGROUND: Abdominal pain is the dominant symptom in 50-75% of patients with chronic pancreatitis, often requiring opioid analgesics. Fentanyl, a potent synthetic opioid, can be administered percutaneously at a constant dose and is claimed to have fewer systemic side effects. AIM: To evaluate transdermal fentanyl plaster versus sustained release morphine tablets as analgesic treatment of painful chronic pancreatitis. METHODS: In an open randomized crossover trial, 18 patients were included. The treatment period was 4 wk for each drug. All patients had immediate-release morphine tablets as rescue medication. RESULTS: The dosage of transdermal fentanyl had to be increased on average 50% over that indicated by the manufacturer. When this was done and rescue medication was secured, no difference between the two drugs in primary endpoint or patient preference was observed. There was also no difference in the secondary endpoints, pain control, and quality of life. However, skin side effects, mostly mild, occurred in 44% of the patients during treatment with transdermal fentanyl, and the mean daily dose of immediate release morphine was significantly higher during the transdermal fentanyl period than during the sustained-release morphine period (30.7 mg vs. 14.7 mg [p < 0.01]). CONCLUSION: When given in an appropriate dose, transdermal fentanyl might be useful for treatment of some patients with painful chronic pancreatitis, e.g., when tablet ingestion is difficult. However, the dosage often has to be increased above that recommended by the manufacturer. The need of rescue morphine is considerable and skin side effects often occur. Transdermal fentanyl is, therefore, not the ideal first-choice analgesic in patients with painful chronic pancreatitis.     

消痛散联合吗啡缓释片治疗晚期肝癌癌痛的临床研究

目的：探讨中医外治法对晚期肝癌癌痛的疗效。方法：将符合纳入标准的晚期肝癌癌痛患者82例随机分为两组：对照组42例,联合组40例。对照组患者按常规给予吗啡缓释片治疗,联合组患者在此基础上加用消痛散外敷。治疗4周后观察两组镇痛效果,进行视觉模拟疼痛评分（ VAS）及生活质量评分,并观察比较治疗前后吗啡用量的变化,同时记录不良反应。结果：治疗4周后,对照组显效率为64.3％,总有效率为69.0％;联合组显效率为75.0％,有效率为95.0％,联合组明显优于对照组,差异均有统计学意义（ P＜0.05）。与治疗前比较,两组VAS评分及生活质量评分均有改善,且联合组较对照组改善更为明显,差异有统计学意义（ P＜0.05）。相关性分析表明,患者VAS评分与生活质量评分呈负相关（r＝-0.75, P＝0.041）,随着VAS评分的降低,患者生活质量显著改善。对照组治疗前后吗啡用量无显著变化,分别为（50.5±2.3） mg/d和（48.3±2.5） mg/d,而联合组治疗前后吗啡用量分别为（51.1±3.0） mg/d和（31.3±2.1） mg/d,差异有统计学意义（P＜0.05）,且治疗组患者治疗后吗啡用量亦显著低于对照组（ P＜0.05）。结论：消痛散外敷联合吗啡缓释片可有效改善晚期肝癌患者的癌痛,提高患者生活质量,减少吗啡的用量,且无明显不良反应。     

Role of supportive care in lung cancer

Lung cancer is a bad prognostic illness with a limited survival and many side effects related to treatment used. Supportive care in cancer attends to enhance patient care among cancer and treatments suffering. Opioids are one of the most important treatments in the management of dyspnoea and pain. Every new drug in supportive care is tested to diminish side effects of treatment like erythropoietin against anemia or aprepitant against emesis. Many trials are developed to enhance this supportive care especially in lung cancer management.